Racial and Socioeconomic Disparities in Utilization of Telehealth in Patients with Liver Disease During COVID-19

Wegermann, Kara; Wilder, Julius; Parish, Alice; Niedzwiecki, Donna; Gellad, Ziad F.; Muir, Andrew J.; Patel, Yuval A.

doi:10.1007/s10620-021-06842-5

Cited by 88 publications

(119 citation statements)

References 14 publications

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“…The COVID-19 pandemic has already been demonstrated to disproportionately impact the health and financial status of vulnerable communities and several recent studies have identified socioeconomic disparities in telehealth use in other medical specialties. 5 , 6 , 7 , 9 , 20 Our findings mirror many of these reports and show that older age was significantly associated with a lower likelihood of completing a video-based appointment but not a phone-based visit. This is unsurprising given that telephone visits are more easily accessible for patients inexperienced with technology and increasing age is associated with lower internet access via broadband or cellular network as well as lower ownership of digital devices necessary for video interfacing including laptops and smart phones.…”

Section: Discussionsupporting

confidence: 87%

“…Our study also found that Black/African American and Hispanic/Latino patients had significantly lower uptake of both video as well as audio-only telehealth, a disparity that has been described in reports prior to and during the pandemic. 8 , 9 , 13 Similar to elderly individuals, ethnic minorities have slightly lower rates of smartphone ownership (82% among Whites, 80% among Blacks and 79% among Hispanics) but significantly lower rates of broadband access (79% among Whites, 66% among Blacks and 61% among Hispanics) in the United States. 11 , 12 , 21 These differences reflect wealth disparities among racial groups in the US, and the additional financial strain imposed by the COVID-19 pandemic may further exacerbate disparate technology access.…”

Section: Discussionmentioning

confidence: 99%

“…However, research during the COVID-19 pandemic has identified lower rates of telehealth utilization among vulnerable patient populations in other medical specialties. 5 , 6 , 7 , 8 , 9 These differences in use mirror disparities in access to technology required for virtual visits including laptop ownership and broadband internet subscription. 10 , 11 , 12 One recent study of a single-institution identified demographic differences in the rates of in-person visits for eyecare during the pandemic, 13 however there remains a paucity of literature about disparities in the uptake of telemedicine in ophthalmology, a field in which demographic differences in care utilization have been identified even prior to the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic

2022

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic

2022

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“…This issue includes patients with CLD for which socioeconomic disparities in American non-Hispanic Black and Hispanic communities have been associated with an increased risk of SARS-CoV-2 infection 101 . In addition, racial and socioeconomic disparities in internet access have been shown to translate into barriers for the use of telehealth, particularly video technology, in patients with CLD 102 .…”

Section: Sars-cov-2 Infection and Liver Disease Clinical Course And Omentioning

confidence: 99%

COVID-19 and liver disease: mechanistic and clinical perspectives

Marjot

Webb

Barritt

et al. 2021

Nat Rev Gastroenterol Hepatol

302

393

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Our understanding of the hepatic consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its resultant coronavirus disease 2019 (COVID-19) has evolved rapidly since the onset of the pandemic. In this Review, we discuss the hepatotropism of SARS-CoV-2, including the differential expression of viral receptors on liver cell types, and we describe the liver histology features present in patients with COVID-19. We also provide an overview of the pattern and relevance of abnormal liver biochemistry during COVID-19 and present the possible underlying direct and indirect mechanisms for liver injury. Furthermore, large international cohorts have been able to characterize the disease course of COVID-19 in patients with pre-existing chronic liver disease. Patients with cirrhosis have particularly high rates of hepatic decompensation and death following SARS-CoV-2 infection and we outline hypotheses to explain these findings, including the possible role of cirrhosis-associated immune dysfunction. This finding contrasts with outcome data in pharmacologically immunosuppressed patients after liver transplantation who seem to have comparatively better outcomes from COVID-19 than those with advanced liver disease. Finally, we discuss the approach to SARS-CoV-2 vaccination in patients with cirrhosis and after liver transplantation and predict how changes in social behaviours and clinical care pathways during the pandemic might lead to increased liver disease incidence and severity.

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“…However, this rise in telemedicine did not reach all patient groups equally, potentially exacerbating health care disparities, as reported in other fields of medicine. [6][7][8] We herein assess the demographic characteristics of patients who did and did not use telehealth for ophthalmic care at a large tertiary care eye center during the COVID-19 pandemic.…”

mentioning

confidence: 99%

Association of Patient Characteristics With Delivery of Ophthalmic Telemedicine During the COVID-19 Pandemic

et al. 2021

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IMPORTANCE Telemedicine has been shown to have had reduced uptake among historically marginalized populations within multiple medical specialties during the COVID-19 pandemic. An evaluation of health disparities among patients receiving ophthalmic telemedical care during the pandemic is needed.OBJECTIVE To evaluate disparities in the delivery of ophthalmic telemedicine at Massachusetts Eye and Ear (MEE) during the COVID-19 pandemic.DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study analyzed clinical visits at a single tertiary eye care center (MEE) from January 1 to December 31, 2020. Patients who had ophthalmology and optometry clinical visits at the MEE during the study period were included. EXPOSURES Telemedicine vs in-person clinical encounters. MAIN OUTCOMES AND MEASURESVariables associated with use of ophthalmic telemedicine during the study period.RESULTS A total of 2262 telemedicine ophthalmic encounters for 1911 patients were included in the analysis. The median age of the patients was 61 (interquartile range, 43-72) years, and 1179 (61.70%) were women. With regard to race and ethnicity, 87 patients (4.55%) identified as Asian; 128 (6.70%), as Black or African American; 23 (1.20%), as Hispanic or Latino; and 1455 (76.14%), as White. On multivariate analysis, factors associated with decreased receipt of telemedical care included male sex (odds ratio [OR], 0.86; 95% CI, 0.77-0.96), Black race (OR, 0.69; 95% CI, 0.56-0.86), not speaking English (OR, 0.63; 95% CI, 0.48-0.81), educational level of high school or less (OR, 0.83; 95% CI, 0.71-0.97), and age (OR per year of age, 0.99; 95% CI, 0.989-0.998). When comparing telephone-and video-based telemedicine visits, decreased participation in video-based visits was associated with age (OR per year of age, 0.96; 95% CI, 0.94-0.98), educational level of high school or less (OR, 0.54; 95% CI, 0.29-0.99), being unemployed (OR, 0.28; 95% CI, 0.12-0.68), being retired (OR, 0.22; 95% CI, 0.10-0.42), or having a disability (OR, 0.09; 95% CI, 0.04-0.23). CONCLUSIONS AND RELEVANCEThe findings of this cross-sectional study, though limited to retrospective data from a single university-based practice, suggest that historically marginalized populations were less likely to receive ophthalmic telemedical care compared with in-person care during the first year of the COVID-19 pandemic in the US. Understanding the causes of these disparities might help those who need access to virtual care.

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Racial and Socioeconomic Disparities in Utilization of Telehealth in Patients with Liver Disease During COVID-19

Cited by 88 publications

References 14 publications

Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic

Socioeconomic and Demographic Disparities in the Use of Telemedicine for Ophthalmic Care during the COVID-19 Pandemic

COVID-19 and liver disease: mechanistic and clinical perspectives

Association of Patient Characteristics With Delivery of Ophthalmic Telemedicine During the COVID-19 Pandemic

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